PEP & PrEP
PEP (Post Exposure Prophylaxis) is emergency medicine that may stop you developing an HIV infection if you’ve been exposed to the virus. PEP is available at cliniQ, most large sexual health clinics and A&E departments. There is more info about PEP on our PEP PAGE.
PrEP stands for pre-exposure prophylaxis:
PRE = Before
EXPOSURE = a risk for HIV infection (sex without condoms/condom breakage)
PROPHYLAXIS = treatment to prevent infection
PrEP is a way of preventing HIV infection by taking a pill. This is either daily, or based around your sexual activity and risk. PrEP is taken by people who don’t have HIV to stay HIV negative.
PrEP is very effective, but only when people take the tablets as directed.
PrEP doesn’t affect or interact with hormone treatment. But please speak to your sexual health team about any drugs (including oestrogen or testosterone) that you take.
Trans women & trans feminine people: Although most studies looked at anal sex, PrEP is also thought to be effective if you have had a vaginoplasty. More studies are starting to look at PrEP in trans women. Talk to your sexual health team about how PrEP can help you stay negative.
Trans men & trans masculine people:
Talk to your sexual health team about PrEP. Let them know the kinds of sex you have.
- PrEP can be taken daily or just when you need it, but options depend on the type of sex you’re having.
- Anal sex has different dosing options, including being used just before and after sex.
- Front hole protection needs daily dosing for at least six days a week. PrEP needs to be taken for a week before it reaches the best levels for protection.
Trans guys taking testosterone (T).
T might reduce your natural lubrication and thin the tissue inside the front hole. We don’t know if this is likely to make PrEP less effective, or change how long it takes for PrEP to reach protective levels. Daily PrEP is therefore the best option.
PrEP is now available on the NHS at sexual health services.
After many years of campaigning by CliniQ and others, this is a great success.
Many people also buy PrEP online from various sources. i-Base have produced a helpful guide.
More on PrEP & Trans People
PrEP is thought to be effective protection from HIV for trans women, but more studies would be useful. New analysis of a large, international study called iPrEX has looked more closely at the experiences of more than 300 trans women involved in the trial. “While this analysis did not include a large enough sample group to draw firm conclusions, we did find strong evidence pointing to efficacy,” said principal investigator Robert Grant from the University of California at San Francisco. “Additional research designed specifically for transgender women is needed to confirm this finding.”
To date, no non-binary people or trans men have been included in clinical trials of PrEP. What we know so far is that for protective levels of the drug to be reached in both the blood and the rectum, PrEP needs to be taken daily for 4 to 7 days. For non-trans women, it takes up to three weeks for protective levels to be reached in the vagina and the cervix. None of the research evidence we have currently takes into account men who may be having receptive vaginal AND anal sex. It also doesn’t account for trans men’s experience of vaginal atrophy; a shrinking and thinning of the vaginal walls, which can occur during testosterone therapy.
If you think that PrEP is something you would like to add to your ‘sexual health toolkit’ Prepster have a great range of suggestions on how best to spread the word, and demand access for PrEP on the NHS.